Development and validation of risk scoring system for prediction of cancer cervix.

ABSTRACT

A Hospital based group matched case-control study was conducted to devise a risk scoring system for the prediction of cancer cervix at the Gynecology Clinic, Government Medical College Hospital, Nagpur, India. The study consisted of 230 cases of cancer cervix (histopathologically confirmed) and equal number of controls, group matched for age. The risk factors considered were Illiteracy, long duration of married life (>25 years), Early Menarche (<13 years), marital status (widow, separated, divorcee), multiparity (> 3), h/o abortion, h/o tobacco use, h/o passive smoking, poor genital hygiene, (grade III & IV) and low socioeconomic status. Statistical Analysis included unconditional multiple logistic regression analysis Receiver Operating Characteristic (ROC) curve analysis. The overall predictive accuracy was calculated by Wilcoxon statistic as an equivalent of area under ROC curve. Five risk factors, illiteracy, poor genital hygiene, long duration of married life, multiparity and early menarche were identified to be significantly associated with cancer cervix. These factors were given statistical weights of 13, 10, 7, 5 and 5 respectively. A total score of 21 was found to be the best cut off for prediction and the overall predictive accuracy of the risk scoring system was calculated to be 0.74(0.67 - 0.81). In case of consistent further validation using other data sets this additive risk scoring system can be used for reducing the cost of universal screening by subjecting only high-risk subjects to laboratory screening procedure (Pap smear) in population setting.